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MacDonald-Nethercott M, Ahmed N, Tanner N, Finch G. Extrahepatic gallstones and abscess formation post-cholecystostomy: a rare complication in high-risk acute cholecystitis management. BMJ Case Rep 2024; 17:e262347. [PMID: 39327036 DOI: 10.1136/bcr-2024-262347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2024] Open
Abstract
This intriguing case report explores an interesting complication following percutaneous cholecystostomy for the management of acute cholecystitis in an elderly female with multiple comorbidities. Despite initial improvement, she later presented with recurrent symptoms, due to a collection of gallstones, that had migrated through the cholecystostomy tract, requiring exploration, stone retrieval and abscess drainage. While percutaneous cholecystostomy remains an effective treatment for managing acute cholecystitis in high-risk surgical candidates, this case highlights the rare yet critical risk of extrahepatic gallstones and abscess formation. It emphasises the necessity for vigilance in detecting and managing complications associated with percutaneous transhepatic cholecystostomy, ensuring timely diagnosis and effective treatment.
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Affiliation(s)
- Meiling MacDonald-Nethercott
- General Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
- General Surgery, Northampton General Hospital NHS Trust, Northampton, UK
| | - Naeem Ahmed
- Northampton General Hospital NHS Trust, Northampton, UK
| | - Nicola Tanner
- Northampton General Hospital NHS Trust, Northampton, UK
| | - Guy Finch
- Northampton General Hospital NHS Trust, Northampton, UK
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2
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Neitzel E, Laskus J, Mueller PR, Kambadakone A, Srinivas-Rao S, vanSonnenberg E. Part 1: Current Concepts in Radiologic Imaging and Intervention in Acute Cholecystitis. J Intensive Care Med 2024:8850666241259421. [PMID: 38839258 DOI: 10.1177/08850666241259421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
Acute calculous cholecystitis and acute acalculous cholecystitis are encountered commonly among critically ill, often elderly, patients. Multidisciplinary management of these conditions is essential, with intensivists, surgeons, diagnostic radiologists, interventional radiologists, infectious disease physicians, gastroenterologists, and endoscopists able to contribute to patient care. In this article intended predominantly for intensivists, we will review the imaging findings and radiologic treatment of critically ill patients with acute calculous cholecystitis and acute acalculous cholecystitis.
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Affiliation(s)
- Easton Neitzel
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Julia Laskus
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Peter R Mueller
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shravya Srinivas-Rao
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric vanSonnenberg
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
- Department of Radiology and Department of Student Affairs, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
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3
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Curry J, Chervu N, Cho NY, Hadaya J, Vadlakonda A, Kim S, Keeley J, Benharash P. Percutaneous cholecystostomy tube placement as a bridge to cholecystectomy for grade III acute cholecystitis: A national analysis. Surg Open Sci 2024; 18:6-10. [PMID: 38312302 PMCID: PMC10831282 DOI: 10.1016/j.sopen.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/10/2024] [Indexed: 02/06/2024] Open
Abstract
Introduction Percutaneous cholecystostomy (PCT) is an alternative to cholecystectomy (CCY) in high-risk surgical candidates with severe acute cholecystitis. A subset of these patients ultimately undergo delayed CCY. We therefore compared outcomes of delayed CCY in patients with grade III acute cholecystitis who received a PCT on index admission, to those who did not. Methods Non-elective adult hospitalizations for grade III acute cholecystitis that underwent delayed CCY were identified in the 2016-2020 Nationwide Readmission Database. Patients who received a PCT during their index admission comprised the PCT group (others: Non-PCT). Outcomes were assessed for the CCY hospitalization. Entropy balancing was used to generate sample weights to adjust for differences in baseline characteristics. Regression models were created to evaluate the association between PCT and the outcomes of interest. Results Of an estimated 13,782 patients, 13.3 % comprised PCT. Compared to Non-PCT, PCT were older (71.1 ± 13.1 vs 67.4 ± 15.3 years) and more commonly in the highest income quartile (22.5 vs 16.1 %, both p < 0.001). After risk adjustment, PCT was associated with reduced odds of respiratory (AOR 0.67, CI 0.54-0.83) and infectious (AOR 0.77, CI 0.62-0.96) complications after eventual CCY. Finally, PCT had comparable pLOS (β +0.31, CI [-0.14, 0.77]) and operative hospitalization costs (β $800, CI [-2300, +600]). Conclusion In the present study, PCT was associated with decreased odds of perioperative complications and comparable resource utilization upon readmission CCY. Our findings suggest that PCT may be helpful in bridging patients with grade III acute cholecystitis to eventual CCY.
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Affiliation(s)
- Joanna Curry
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, California, USA
| | - Nikhil Chervu
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, California, USA
- Department of Surgery, David Geffen School of Medicine at UCLA, University of California Los Angeles, California, USA
| | - Nam Yong Cho
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, California, USA
| | - Joseph Hadaya
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, California, USA
- Department of Surgery, David Geffen School of Medicine at UCLA, University of California Los Angeles, California, USA
| | - Amulya Vadlakonda
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, California, USA
| | - Shineui Kim
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, California, USA
| | - Jessica Keeley
- Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), University of California Los Angeles, California, USA
- Department of Surgery, David Geffen School of Medicine at UCLA, University of California Los Angeles, California, USA
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Bozic D, Ardalic Z, Mestrovic A, Bilandzic Ivisic J, Alicic D, Zaja I, Ivanovic T, Bozic I, Puljiz Z, Bratanic A. Assessment of Gallbladder Drainage Methods in the Treatment of Acute Cholecystitis: A Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:5. [PMID: 38276039 PMCID: PMC10817550 DOI: 10.3390/medicina60010005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024]
Abstract
Gallbladder drainage is a treatment option in high-risk surgical patients with moderate or severe acute cholecystitis. It may be applied as a bridge to cholecystectomy or a definitive treatment option. Apart from the simple and widely accessible percutaneous cholecystostomy, new attractive techniques have emerged in the previous decade, including endoscopic transpapillary gallbladder drainage and endoscopic ultrasound-guided gallbladder drainage. The aim of this paper is to present currently available drainage techniques in the treatment of AC; evaluate their technical and clinical effectiveness, advantages, possible adverse events, and patient outcomes; and illuminate the decision-making path when choosing among various treatment modalities for each patient, depending on their clinical characteristics and the accessibility of methods.
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Affiliation(s)
- Dorotea Bozic
- Department of Gastroenterology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (Z.A.); (A.M.); (D.A.); (I.Z.); (Z.P.); (A.B.)
| | - Zarko Ardalic
- Department of Gastroenterology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (Z.A.); (A.M.); (D.A.); (I.Z.); (Z.P.); (A.B.)
| | - Antonio Mestrovic
- Department of Gastroenterology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (Z.A.); (A.M.); (D.A.); (I.Z.); (Z.P.); (A.B.)
| | - Josipa Bilandzic Ivisic
- Department of Gastroenterology, General Hospital of Sibenik-Knin County, Stjepana Radica 83, 22000 Sibenik, Croatia;
| | - Damir Alicic
- Department of Gastroenterology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (Z.A.); (A.M.); (D.A.); (I.Z.); (Z.P.); (A.B.)
| | - Ivan Zaja
- Department of Gastroenterology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (Z.A.); (A.M.); (D.A.); (I.Z.); (Z.P.); (A.B.)
- University Department of Health Studies, University of Split, Rudjera Boskovica 35, 21000 Split, Croatia
| | - Tomislav Ivanovic
- Department of Abdominal Surgery, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia;
| | - Ivona Bozic
- Department of Rheumatology and Immunology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia;
| | - Zeljko Puljiz
- Department of Gastroenterology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (Z.A.); (A.M.); (D.A.); (I.Z.); (Z.P.); (A.B.)
- School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia
| | - Andre Bratanic
- Department of Gastroenterology, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (Z.A.); (A.M.); (D.A.); (I.Z.); (Z.P.); (A.B.)
- School of Medicine, University of Split, Soltanska 2, 21000 Split, Croatia
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Arkoudis NA, Moschovaki-Zeiger O, Reppas L, Grigoriadis S, Alexopoulou E, Brountzos E, Kelekis N, Spiliopoulos S. Percutaneous cholecystostomy: techniques and applications. Abdom Radiol (NY) 2023; 48:3229-3242. [PMID: 37338588 DOI: 10.1007/s00261-023-03982-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023]
Abstract
Acute cholecystitis (AC) is a critical condition requiring immediate medical attention and treatment and is one of the most frequently encountered acute abdomen emergencies in surgical practice, requiring hospitalization. Laparoscopic cholecystectomy is considered the favored treatment for patients with AC who are fit for surgery. However, in high-risk patients considered poor surgical candidates, percutaneous cholecystostomy (PC) has been suggested and employed as a safe and reliable alternative option. PC is a minimally invasive, nonsurgical, image-guided intervention that drains and decompresses the gallbladder, thereby preventing its perforation and sepsis. It can act as a bridge to surgery, but it may also serve as a definitive treatment for some patients. The goal of this review is to familiarize physicians with PC and, more importantly, its applications and techniques, pre- and post-procedural considerations, and adverse events.
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Affiliation(s)
- Nikolaos-Achilleas Arkoudis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece.
| | - Ornella Moschovaki-Zeiger
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Lazaros Reppas
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
- Interventional Radiology Department, Bioclinic General Hospital of Athens, Marinou Geroulanou 15, 115 24, Athens, Greece
| | - Stavros Grigoriadis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Efthymia Alexopoulou
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Elias Brountzos
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, University General Hospital "Attikon", Rimini 1, Haidari, 124 62, Athens, Greece
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Arkoudis NA, Moschovaki-Zeiger O, Grigoriadis S, Palialexis K, Reppas L, Filippiadis D, Alexopoulou E, Brountzos E, Kelekis N, Spiliopoulos S. US-guided trocar versus Seldinger technique for percutaneous cholecystostomy (TROSELC II trial). Abdom Radiol (NY) 2023; 48:2425-2433. [PMID: 37081229 DOI: 10.1007/s00261-023-03916-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVES The purpose of this study is to investigate the safety and effectiveness of the US-guided bedside trocar vs. the Seldinger technique for percutaneous cholecystostomy (PC) procedures. METHODS This is a prospective single-center, randomized, controlled trial (RCT) comparing the trocar (group T; 50 patients [27 men]; mean [± SD] age, 74.16 ± 15.59 years) with the Seldinger technique for PC (group S; 50 patients [23 men]; mean [± SD] age, 80.78 ± 14.09 years) in consecutive patients undergoing the procedure in a bedside setting with the sole employment of US as a guidance modality. Primary outcomes consisted of technical success and complications associated with the procedure. Secondary outcome measures involved procedure duration, intra-/post-procedure pain evaluation, and clinical success. RESULTS PC was technically successful for all 100 patients. Clinical success rates were similar between group T and S (94% vs. 92%, respectively; p = 0.34). Equal total procedure-related complications were noted in both groups (4% vs. 4%; p = 0.5). A minor bleeding event (bile mixed with blood) occurred in one patient (2%) in group T and one patient (2%) in group S; accidental catheter dislodgement in one patient (2%) from group T, and a small biloma in one patient (2%) from group S. No procedure-related deaths or major bleeding events were noted. PC was significantly faster in group T (1.41 ± 1.13 vs. 4.41 ± 2.68 min; p < 0.001). Mean pain score during PC was significantly lower in group T compared with group S at 12 h of follow-up (1.43 ± 1.45 vs. 3.36 ± 2.05; p < 0.01). CONCLUSION US-guided bedside trocar technique for PC was equally effective and safe as the Seldinger technique, but it was faster and simpler to perform and led to reduced pain following the procedure.
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Affiliation(s)
- Nikolaos-Achilleas Arkoudis
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece.
| | - Ornella Moschovaki-Zeiger
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Stavros Grigoriadis
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Konstantinos Palialexis
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Lazaros Reppas
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
- Interventional Radiology Department, Bioclinic General Hospital of Athens, Marinou Geroulanou 15, 115 24, Athens, Greece
| | - Dimitrios Filippiadis
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Efthymia Alexopoulou
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Elias Brountzos
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, School of Medicine, University General Hospital "Attikon", National and Kapodistrian University of Athens, Rimini 1, Haidari, 124 62, Athens, Greece
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Sundaram KM, Morgan MA, Depetris J, Arif-Tiwari H. Imaging of benign gallbladder and biliary pathologies in pregnancy. Abdom Radiol (NY) 2023; 48:1921-1932. [PMID: 36790454 DOI: 10.1007/s00261-023-03832-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 02/16/2023]
Abstract
The rising incidence combined with pregnancy-related physiological changes make gallbladder and biliary pathology high on the differential for pregnant patients presenting with right upper abdominal pain. Imaging plays a crucial role in determining surgical versus non-surgical management in pregnant patients with biliary or gallbladder pathology. Ultrasound (first-line) and magnetic resonance with magnetic resonance cholangiopancreatography (second-line) are the imaging techniques of choice in pregnant patients with suspected biliary pathology due to their lack of ionizing radiation. MRI/MRCP offers an excellent non-invasive imaging option, providing detailed anatomical detail without known harmful fetal side effects. This article reviews physiological changes in pregnancy that lead to gallstone and biliary pathology, key imaging findings on US and MRI/MRCP, and management pathways.
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Affiliation(s)
- Karthik M Sundaram
- Department of Radiology, University of Pennsylvania Health System, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, USA.
| | - Matthew A Morgan
- Department of Radiology, University of Pennsylvania Health System, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, USA
| | - Jena Depetris
- Department of Radiology, University of California Los Angeles, 757 Westwood Plaza, Los Angeles, CA, USA
| | - Hina Arif-Tiwari
- Department of Radiology, University of Arizona-Tuscon, 1501 N. Campbell Avenue, Tuscon, AZ, USA
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Jenkins PE, MacCormick A, Zhong J, Makris GC, Gafoor N, Chan D. Transhepatic or transperitoneal technique for cholecystostomy: results of the multicentre retrospective audit of cholecystostomy and further interventions (MACAFI). Br J Radiol 2023. [DOI: 10.1259/bjr.20220279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Objective: This analysis of the MACAFI (multicentre audit of cholecystostomy and further interventions) data aims to assess the procedural technique and technical specifications related to percutaneous cholecystostomy (PC) insertion in patients with acute calculous cholecystitis (ACC). PC can be performed either with transperitoneal (TP) or a transhepatic (TH) approach. There is no clear evidence for the superiority of either technique. Methods: The data set included patients who underwent PC for ACC between first January 2019 and first January 2021. Data included patient demographics, imaging diagnosis, insertion technique, tube size, and outcomes including 6 month follow-up. Results: 1186 patients from 36 sites were identified through the MACAFI study with 913 patients having access route recorded. A transhepatic route was used in 572 [62.6%] compared to 308 TP [33.7%]. There was an increased rate of bleeding when using the TH route (2.6% vs 0.3%, p = 0.01) although other post-procedural complications (such as bile leak) were similar between the two groups. No significant difference was demonstrated in 30- or 90-day mortality (TH vs TP, 8.7vs 9.3%, p = 0.86 and 13.8vs 15.4%, p = 0.58, respectively). The readmission rate with recurrent cholecystitis was significantly greater in those with TH compared to TP approach (22.0% vs 14.9%, p = 0.01, respectively). Conclusion: The TP PC approach may be safer than TH, with lower bleeding complication rate and fewer readmissions. Advances in knowledge: A transperitoneal approach for cholecystostomy was associated with lower bleeding complication rate and lower rate of readmissions with recurrent cholecystitis compared to the transhepatic approach.
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Affiliation(s)
- Paul Edward Jenkins
- Peninsula Radiology Academy, Plymouth PL6 5WR, England, United Kingdom
- Department of Interventional Radiology, University Hospital Plymouth NHS Trust, Plymouth, UK
| | - Andrew MacCormick
- Peninsula Radiology Academy, Plymouth PL6 5WR, England, United Kingdom
| | - Jim Zhong
- Department of Diagnostic and Interventional Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Gregory C Makris
- Department of Interventional Radiology, University Hospitals Plymouth NHS Trust, PL6 8DH, England, United Kingdom
| | - Nelofer Gafoor
- Department of Upper GI Surgery, University Hospitals Plymouth NHS Trust, PL6 8DH, England, United Kingdom
| | - David Chan
- Department of Interventional Radiology, St Thomas’ Hospital, Guys and St Thomas NHS Foundation Trust, Westminster Bridge Rd, London, United Kingdom
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Hamid M, Khalid A, Parmar J. Does percutaneous cholecystostomy timing in high anaesthetic-risk patients impact on outcome? Updates Surg 2023; 75:133-140. [PMID: 36333564 DOI: 10.1007/s13304-022-01405-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
The optimal timing for percutaneous cholecystostomy (PCT) in patients with acute biliary sepsis, who are high-risk for cholecystectomy, requires further investigation. We aimed to study local factors influencing the timing to PCT placement, and investigate patient outcomes in early (≤ 48 h) vs. delayed PCT over a six-year period. A retrospective observational study investigating patients who required a PCT at a single hospital in the UK between January 2014 and December 2019. Placement of a PCT was at the discretion of the on-call surgical consultant according to their own personal experience and not based on a standard local protocol. Clinical outcomes, hospital statistics and details of any subsequent bridging surgery were analysed using multivariate logistic regression models adjusting for age, sex, Charlson Comorbidity Index (CCI) and American Society of Anaesthesiologists (ASA) grade. There were 72 patients with 35/72 (48.6%) classed as TG18 AC grade 3; 26/72 (36.1%) had an early PCT placed and 46/72 (63.9%) delayed. Median age was 76 (65-83) years, 52.8% were female, and 51.4% were classed ASA ≥ 3 with 94.0% scoring CCI > 2. Trial on antibiotic therapy was the primary reason for delayed PCT. In adjusted models, early PCT was associated with a shorter length in hospital stay (OR 3.02, p = 0.044), successful definitive treatment (OR 6.26, p = 0.009); and reduced likelihood for catheter dislodgment (OR 0.12, p = 0.004) with fewer patients bridging to later emergency open surgery (OR 0.19, p = 0.024). Clinical outcomes may be superior in urgent or early PCT for high anaesthetic-risk patients following acute biliary sepsis.
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Affiliation(s)
- Mohammed Hamid
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TH, UK. .,Department of Upper Gastrointestinal Surgery, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK.
| | - Ayesha Khalid
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TH, UK.,Department of Upper Gastrointestinal Surgery, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK
| | - Jitesh Parmar
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TH, UK.,Department of Upper Gastrointestinal Surgery, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK
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10
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Pepin EW, Nordeck SM, Fetzer DT. Nontraditional Uses of US Contrast Agents in Abdominal Imaging and Intervention. Radiographics 2022; 42:1724-1741. [DOI: 10.1148/rg.220016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Eric W. Pepin
- From the Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9096
| | - Shaun M. Nordeck
- From the Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9096
| | - David T. Fetzer
- From the Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9096
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11
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Singh AK. Percutaneous Cholecystostomy: A Bridge to Less Morbidity. THE ARAB JOURNAL OF INTERVENTIONAL RADIOLOGY 2022. [DOI: 10.1055/s-0042-1744213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
AbstractPercutaneous cholecystostomy (PC) is a minimally invasive procedure for decompressing gall bladder (GB) or biliary system in emergency settings, performed in patients with GB or biliary diseases who are at high risk for surgical exploration. Indications range from acute cholecystitis in seriously ill patients to overdistended GB with impending perforation to overt GB perforation. This procedure, by allowing biliary drainage, helps in controlling the infection and optimizing the patient's condition for definitive treatment in the form of elective surgery if possible, thus acting as a bridge to a definitive treatment option. In some cases, such as acute acalculous cholecystitis, it may obviate the need for surgery, and in malignant biliary obstruction, it may be used as a palliative measure to keep GB decompressed. This review article focuses on and revisits many aspects of PC including technical aspects, clinical indications, outcomes, and safety of the procedure, in addition to its role as bridge therapy versus definitive therapy versus palliative option. It includes observations based on the author's own work experience and review of the literature.
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Affiliation(s)
- Anil Kumar Singh
- Department of Radiodiagnosis, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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12
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Shin MH, Choi NK. Feasibility of surgeon-performed percutaneous transhepatic gallbladder drainages in patients with acute cholecystitis. Ann Surg Treat Res 2022; 102:257-262. [PMID: 35611088 PMCID: PMC9111964 DOI: 10.4174/astr.2022.102.5.257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/25/2022] [Accepted: 03/10/2022] [Indexed: 12/07/2022] Open
Abstract
Purpose This study aimed to evaluate the feasibility of surgeon-performed percutaneous transhepatic gallbladder drainage (PTGBD). Methods Patients treated with PTGBD for acute cholecystitis (AC), performed by surgeons at Chosun University Hospital for 12 months between March 2017 and February 2018, were enrolled retrospectively, into the S-PTGBD group (n = 134). Patients with PTGBD performed by interventional radiologists for 12 months, 6 months before March 2017, and after February 2018, were included in the X-PTGBD group (n = 107). In addition to the basic characteristics of the patients, severity of AC, comorbidities, intervals from hospital admission to the PTGBDs, procedural times, technical success rates, intention-to-treat rates, and complication rates were evaluated and compared. Results Except for the patient’s age (older in S-PTGBD), there were no differences in the patient’s basic profiles, including the severity of the AC and comorbidities. Although the procedural times were significantly shorter in the X-PTGBD group (18.13 minutes vs. 11.39 minutes), effectiveness indicators such as the technical success rates and intention-to-treat rates and safety, such as the major complication rates in the S-PTGBD group, were comparable with those in the X-PTGBD group. The intervals between hospital admissions and PTGBDs were shorter in the S-PTGBD group, although this difference disappeared in the high-risk group. Effectiveness and safety in the high-risk group were also comparable between the groups. Conclusion The PTGBDs performed by surgeons are as effective and safe as those performed by interventional radiologists with faster implementation of PTGBD.
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Affiliation(s)
- Min-Ho Shin
- Division of Hepato-Biliary-Pancreatic and Transplantation Surgery, Department of Surgery, Chosun University Hospital, Gwangju, Korea
| | - Nam-Kyu Choi
- Division of Hepato-Biliary-Pancreatic and Transplantation Surgery, Department of Surgery, Chosun University Hospital, Gwangju, Korea
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13
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Madhusudhan KS, Jineesh V, Keshava SN. Indian College of Radiology and Imaging Evidence-Based Guidelines for Percutaneous Image-Guided Biliary Procedures. Indian J Radiol Imaging 2021; 31:421-440. [PMID: 34556927 PMCID: PMC8448229 DOI: 10.1055/s-0041-1734222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Percutaneous biliary interventions are among the commonly performed nonvascular radiological interventions. Most common of these interventions is the percutaneous transhepatic biliary drainage for malignant biliary obstruction. Other biliary procedures performed include percutaneous cholecystostomy, biliary stenting, drainage for bile leaks, and various procedures like balloon dilatation, stenting, and large-bore catheter drainage for bilioenteric or post-transplant anastomotic strictures. Although these procedures are being performed for ages, no standard guidelines have been formulated. This article attempts at preparing guidelines for performing various percutaneous image-guided biliary procedures along with discussion on the published evidence in this field.
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Affiliation(s)
| | - Valakkada Jineesh
- Department of Radiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology (Thiruvananthapuram), Kerala, India
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14
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Bennett S, Shaida N, Godfrey E, Safranek P, O'Neill JR. A comparison of transhepatic versus transperitoneal cholecystostomy for acute calculous cholecystitis: a 5-year experience. J Surg Case Rep 2021; 2021:rjab410. [PMID: 34531975 PMCID: PMC8440141 DOI: 10.1093/jscr/rjab410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 12/07/2022] Open
Abstract
Percutaneous cholecystostomy is a treatment for acute calculous cholecystitis used in patients where surgery is high risk or challenging either to allow for surgical optimisation or as definitive treatment. In this case series we compare the outcomes of a transhepatic versus transperitoneal approach in patients undergoing percutaneous cholecystostomy for acute calculous cholecystitis. A retrospective review of patients from 2014 to 2019 was conducted and included demographics, percutaneous cholecystostomy route, complications and outcome. Fifty-one patients were included. Percutaneous cholecystostomy was placed transhepatically in 15 cases; transperitoneal in 30 cases; 6 cases had undetermined route. The transhepatic cohort had 43.5% fewer readmissions due to biliary sepsis, 32.5% fewer drain-related complications, and were less likely to require further treatment (32.5% reduction) compared to the transperitoneal cohort. In our experience, the transhepatic route is preferred due to fewer complications, fewer readmissions and a reduction in the need for further treatment.
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Affiliation(s)
- Stephen Bennett
- Cambridge Oesophago-Gastric Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Nadeem Shaida
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Edmund Godfrey
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Peter Safranek
- Cambridge Oesophago-Gastric Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - J Robert O'Neill
- Cambridge Oesophago-Gastric Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
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15
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Hung YL, Chen HW, Tsai CY, Chen TC, Wang SY, Sung CM, Hsu JT, Yeh TS, Yeh CN, Jan YY. The optimal timing of interval laparoscopic cholecystectomy following percutaneous cholecystostomy based on pathological findings and the incidence of biliary events. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 28:751-759. [PMID: 34129718 DOI: 10.1002/jhbp.1012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/24/2021] [Accepted: 06/02/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The incidence of biliary events (BE) following percutaneous cholecystostomy (PC) in acute cholecystitis (AC) patients is high. Therefore, definitive laparoscopic cholecystectomy (LC) is recommended. We aimed to investigate the optimal timing of LC following PC with regard to the clinical course and pathological findings. METHODS All 744 AC patients with PC were included. The incidence and median number of BE were investigated with the concept of competing risks. The 344 patients with interval LC were divided into two groups based on the pathological findings of resected gallbladders: the acute/acute-and-chronic group (AANC group) (n = 221) and the chronic group (n = 123). A comparative analysis of the demographic data and perioperative outcomes was performed. RESULTS Among the 744 AC patients with PC, 142 patients experienced recurrent BE. The cumulative incidence of BE was 26.6%, and the median time to recurrence was 67.5 days. The PC-to-LC days of the chronic group were longer than those of the AANC group (73.51 vs 63.00, P < .001). The multivariate analysis indicated that the operation time was longer in the AANC group than in the chronic group (P = .040). CONCLUSION In terms of the clinical course and sequential pathological changes in the gallbladder, a 9- to 10-week interval after PC is the optimal timing for LC.
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Affiliation(s)
- Yu-Liang Hung
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Huan-Wu Chen
- Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chun-Yi Tsai
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Tse-Ching Chen
- Department of Anatomic Pathology, College of Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Shang-Yu Wang
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan City, Taiwan
| | - Chang-Mu Sung
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Jun-Te Hsu
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Ta-Sen Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chun-Nan Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Yi-Yin Jan
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
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16
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Huang H, Zhang H, Yang D, Wang W, Zhang X. Percutaneous cholecystostomy versus emergency cholecystectomy for the treatment of acute calculous cholecystitis in high-risk surgical patients: a meta-analysis and systematic review. Updates Surg 2021; 74:55-64. [PMID: 33991327 DOI: 10.1007/s13304-021-01081-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/03/2021] [Indexed: 12/07/2022]
Abstract
The present meta-analysis was performed to compare the efficacy and safety of percutaneous cholecystostomy (PC) versus emergency cholecystectomy (EC) for the treatment of acute calculous cholecystitis (ACC) in high-risk surgical patients. Literature searches for eligible studies were performed using MEDLINE, EMBASE and the Cochrane Library. Quality assessment was conducted in each study. Meta-analyses were performed to demonstrate the pooled effects of relative risk (RR) with 95% confidence intervals (CI). A total of 8960 patients from 6 studies were finally included. PC resulted in increased risks of mortality (RR = 2.87; CI = 1.33-6.18; p = 0.007) and readmission rate (RR = 4.70; CI = 3.30-6.70; p < 0.00001) as compared with EC. No significant difference was detected between PC and EC in terms of morbidity, severe complication rate or hospitalization length. Moreover, PC was associated with significantly higher risks of mortality (RR = 7.47; CI = 1.88-29.72; p = 0.004), morbidity (RR = 3.71; 95% CI = 1.78-7.75; p = 0.0005), readmission rate (RR = 7.91; CI = 3.80-16.49; p < 0.00001), and hospitalization length (WMD = 6.92; CI = 5.89-7.95; p < 0.00001) when directly compared with laparoscopic cholecystectomy (LC). Therefore, EC is superior to PC for the treatment of ACC in high-risk surgical patients, and LC is the preferred surgical strategy.
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Affiliation(s)
- Hejing Huang
- Department of Ultrasound, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Hang Zhang
- Department of Ultrasound, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Dejun Yang
- Department of Gastrointestinal Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Weijun Wang
- Department of Gastrointestinal Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China.
| | - Xin Zhang
- Department of Gastrointestinal Surgery, Changzheng Hospital, Naval Medical University, Shanghai, China.
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17
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Hung YL, Sung CM, Fu CY, Liao CH, Wang SY, Hsu JT, Yeh TS, Yeh CN, Jan YY. Management of Patients With Acute Cholecystitis After Percutaneous Cholecystostomy: From the Acute Stage to Definitive Surgical Treatment. Front Surg 2021; 8:616320. [PMID: 33937313 PMCID: PMC8083985 DOI: 10.3389/fsurg.2021.616320] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/22/2021] [Indexed: 12/17/2022] Open
Abstract
Percutaneous cholecystostomy (PC) has become an important procedure for the treatment of acute cholecystitis (AC). PC is currently applied for patients who cannot undergo immediate laparoscopic cholecystectomy. However, the management following PC has not been well-reviewed. The efficacy of PC tubes has already been indicated, and compared to complications of other invasive biliary procedures, complications related to PC are rare. Following the resolution of AC, patients who can tolerate anesthesia and the surgical risk should undergo interval cholecystectomy to reduce the recurrence of biliary events. For patients unfit for surgery, whether owing to comorbidities, anesthesia risks, or surgical risks, expectant management may be applied; however, a high incidence of recurrence has been noted. In addition, several interesting issues, such as the indications for cholangiography via the PC tube, removal or maintenance of the PC catheter before definitive treatment, and timing of elective surgery, are all discussed in this review, and a relevant decision-making flowchart is proposed. PC is an effective and safe intervention, whether as expectant treatment or bridge therapy to definitive surgery. High-level evidence of post-PC care is still necessary to modify current practices.
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Affiliation(s)
- Yu-Liang Hung
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chang-Mu Sung
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Yuan Fu
- Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Hung Liao
- Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shang-Yu Wang
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jun-Te Hsu
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ta-Sen Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Nan Yeh
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Yin Jan
- Division of General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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18
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England RW, Heiberger C, Singh H. Thinking ahead: gallbladder intussusception following transperitoneal percutaneous cholecystostomy tube placement. BMJ Case Rep 2021; 14:14/2/e238885. [PMID: 33563694 PMCID: PMC7875293 DOI: 10.1136/bcr-2020-238885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Percutaneous cholecystostomy (PC) is a common minimally invasive, image-guided procedure performed primarily on high-risk patients with acute cholecystitis for gallbladder decompression. Herein, we present a case of a patient undergoing PC placement using a transperitoneal approach. On subsequent upsizing attempts, the gallbladder fundus was found to invaginate during advancement of replacement drains, causing gallbladder intussusception. The use of a balloon and locked pigtail catheter were required to reposition the gallbladder to proper position. The patient's planned percutaneous cholecystoscopy was delayed by 4 weeks until intended upsizing could be performed. This case demonstrates the advantage of achieving transhepatic gallbladder access to support tract formation and limit procedural complications.
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Affiliation(s)
- Ryan William England
- The Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Caleb Heiberger
- The Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Harjit Singh
- The Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, Maryland, USA
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19
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Interventional radiological management of hepatobiliary disorders in pregnancy. Clin Exp Hepatol 2020; 6:176-184. [PMID: 33145424 PMCID: PMC7592089 DOI: 10.5114/ceh.2020.99508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/09/2020] [Indexed: 11/17/2022] Open
Abstract
Hepatobiliary disorders are common in pregnancy and pose a management challenge. Minimally invasive interventional radiological (IR) techniques allow safe and effective management of these disorders. However, the available literature is scarce. Radiological interventions in this group of patients mandate a clear understanding of the risks of radiation to the fetus. The IR physician involved in the care of these patients should be aware of the measures to minimize the exposure to ionizing radiation. Additionally, the risk-benefit ratio should be clearly defined in a multidisciplinary discussion involving IR physicians, obstetricians, and gastroenterologists. This review is an effort to address issues related to the application of IR procedures for hepatobiliary disorders in pregnant patients.
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20
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Percutaneous Cholecystostomy Placement in Cases of Non-operative Cholecystitis: A Retrospective Cohort Analysis. World J Surg 2020; 44:4077-4085. [PMID: 32860139 DOI: 10.1007/s00268-020-05752-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Acute (calculous) cholecystitis (AC) is an extremely common surgical presentation, managed by cholecystectomy. Percutaneous cholecystostomy (PC) is an alternative; however, its safety and efficacy, along with subsequent cholecystectomy, are underreported in South Africa, where patients often present late and access to emergency operating theatre is constrained. The aim of the study was to demonstrate the outcomes of PC in patients with AC not responding to antimicrobials. MATERIALS AND METHODS A retrospective cohort review of patient records, who underwent PC in Groote Schuur Hospital, Cape Town, between May 2013 and July 2016, was performed. Patients with PC for malignancy or acalculous cholecystitis were excluded. Technical success, clinical response, procedure-related morbidity and mortality were recorded. Interval LC parameters were investigated. RESULTS Technical success and clinical improvement was seen in 29 of 37 patients (78.38%) who had PC. Malposition (8.11%) was the most common complication. Two patients required emergency surgery (5.4%), while one tube was dislodged. Median tube placement duration was 25 days (range 1-211). Post-procedure, 16 patients (43.24%) went on to have LC, of which 50% (eight patients) required conversion to open surgery and 25% (four) had subtotal cholecystectomy. Median surgical time was 130 min. There were no procedure-related mortalities but eight patients (21.62%) died in the 90-day period following tube insertion. CONCLUSION In patients with AC, PC is safe, with high technical success and low complication rate. Subsequent cholecystectomy should be performed, but is usually challenging. The requirement for PC may predict a more complex disease process.
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21
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Er S, Berkem H, Özden S, Birben B, Çetinkaya E, Tez M, Yüksel BC. Clinical course of percutaneous cholecystostomies: A cross-sectional study. World J Clin Cases 2020; 8:1033-1041. [PMID: 32258074 PMCID: PMC7103974 DOI: 10.12998/wjcc.v8.i6.1033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/11/2020] [Accepted: 03/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although cholecystectomy is the standard treatment modality, it has been shown that perioperative mortality is approaching 19% in critical and elderly patients. Percutaneous cholecystostomy (PC) can be considered as a safer option with a significantly lower complication rate in these patients.
AIM To assess the clinical course of acute cholecystitis (AC) in patients we treated with PC.
METHODS The study included 82 patients with Grade I, II or III AC according to the Tokyo Guidelines 2018 (TG18) and treated with PC. The patients’ demographic and clinical features, laboratory parameters, and radiological findings were retrospectively obtained from their medical records.
RESULTS Eighty-two patients, 45 (54.9%) were male, and the median age was 76 (35-98) years. According to TG18, 25 patients (30.5%) had Grade I, 34 (41.5%) Grade II, and 23 (28%) Grade III AC. The American Society of Anesthesiologists (ASA) physical status score was III or more in 78 patients (95.1%). The patients, who had been treated with PC, were divided into two groups: discharged patients and those who died in hospital. The groups statistically significantly differed only concerning the ASA score (P = 0.0001) and WBCC (P = 0.025). Two months after discharge, two patients (3%) were readmitted with AC, and the intervention was repeated. Nine of the discharged patients (13.6%) underwent interval open cholecystectomy or laparoscopic cholecystectomy (8/1) within six to eight weeks after PC. The median follow-up time of these patients was 128 (12-365) wk, and their median lifetime was 36 (1-332) wk.
CONCLUSION For high clinical success in AC treatment, PC is recommended for high-risk patients with moderate-severe AC according to TG18, elderly patients, and especially those with ASA scores of ≥ III. According to our results, PC, a safe, effective and minimally invasive treatment, should be preferred in cases suffering from AC with high risk of mortality associated with cholecystectomy.
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Affiliation(s)
- Sadettin Er
- Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey
| | - Hüseyin Berkem
- Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey
| | - Sabri Özden
- Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey
| | - Birkan Birben
- Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey
| | - Erdinç Çetinkaya
- Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey
| | - Mesut Tez
- Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey
| | - Bülent Cavit Yüksel
- Department of Surgery, Ankara Numune Training and Research Hospital, Ankara 06100, Turkey
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22
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Reppas L, Arkoudis NA, Spiliopoulos S, Theofanis M, Kitrou PM, Katsanos K, Palialexis K, Filippiadis D, Kelekis A, Karnabatidis D, Kelekis N, Brountzos E. Two-Center Prospective Comparison of the Trocar and Seldinger Techniques for Percutaneous Cholecystostomy. AJR Am J Roentgenol 2020; 214:206-212. [PMID: 31573856 DOI: 10.2214/ajr.19.21685] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE. The purpose of this study is to compare the safety and efficacy of the bedside ultrasound (US)-guided trocar technique versus the US- and fluoroscopy-guided Seldinger technique for percutaneous cholecystostomy (PC). SUBJECTS AND METHODS. This prospective noninferiority study compared the bedside US-guided trocar technique for PC (the trocar group; 53 patients [28 men and 25 women]; mean [± SD] age, 74.31 ± 16.19 years) with the US- and fluoroscopy-guided Seldinger technique for PC (the Seldinger group; 52 patients [26 men and 26 women], mean age, 79.92 ± 13.38 years) in consecutive patients undergoing PC at two large tertiary university hospitals. The primary endpoints were technical success and procedure-related complication rates. Secondary endpoints included procedural duration, pain assessment, and clinical success after up to 3 months of follow-up. RESULTS. PC was successfully performed for all 105 patients. The clinical success rate was similar between the two study groups (86.8% in the trocar group vs 76.9% in the Seldinger group; p = 0.09). Mean procedural time was significantly lower in the trocar group than in the Seldinger group (1.77 ± 1.62 vs 4.88 ± 2.68 min; p < 0.0001). Significantly more procedure-related complications were noted in the Seldinger group than in the trocar group (11.5% vs 1.9%; p = 0.02). Among patients in the Seldinger group, bile leak occurred in 7.7%, abscess formation in 1.9%, and gallbladder rupture in 1.9%. No procedure-related death was noted. Minor bleeding occurred in one patient (1.9%) in the trocar group, but the bleeding resolved on its own. The mean pain score during the procedure was significantly lower in the Seldinger group than in the trocar group (3.2 ± 1.77 vs 4.76 ± 2.17; p = 0.01). At 12 hours after the procedure, the mean pain score was significantly lower for patients in the trocar group (0.78 ± 1.0 vs 3.12 ± 1.36; p = 0.0001). CONCLUSION. Use of the bedside US-guided trocar technique for PC was equally effective as the Seldinger technique but was associated with fewer procedure-related complications, required less procedural time, and resulted in decreased postprocedural pain, compared with fluoroscopically guided PC using the Seldinger technique.
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Affiliation(s)
- Lazaros Reppas
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos-Achilleas Arkoudis
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Michail Theofanis
- Department of Interventional Radiology, Patras University Hospital, University of Patras, Rion, Greece
| | - Panagiotis M Kitrou
- Department of Interventional Radiology, Patras University Hospital, University of Patras, Rion, Greece
| | - Konstantinos Katsanos
- Department of Interventional Radiology, Patras University Hospital, University of Patras, Rion, Greece
| | - Konstantinos Palialexis
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitris Filippiadis
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexis Kelekis
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Karnabatidis
- Department of Interventional Radiology, Patras University Hospital, University of Patras, Rion, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Elias Brountzos
- 2nd Department of Radiology, Division of Interventional Radiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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23
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Hynes D, Aghajafari P, Janne d'Othée B. Role of Interventional Radiology in the Management of Infection. Semin Ultrasound CT MR 2019; 41:20-32. [PMID: 31964492 DOI: 10.1053/j.sult.2019.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Interventional radiology (IR) is plays a crucial role in the management of localized infections, utilizing percutaneous access to loculated fluid collections for drainage and source control. Interventions have been developed in multiple organs and systems and used over decades, allowing the IR physician to provide patient care in many cases where surgical options are not optimal. In this review, we will examine the emergent, urgent, and routine nature of various IR procedures in the infectious context and timelines for each in regards to the decision making process. An algorithmic approach should guide the clinician's decision making for IR procedures in both large academic centers and smaller community hospitals. This approach and the pertinent procedural technique are described for multiple systems and organs including the biliary tree, gallbladder, genitourinary tract, and thoracic, abdominal, and pelvic abscesses. Increased awareness of the abilities and limitations of IR physicians in clinical scenarios needs to be implemented, to allow multispecialty input in efforts to decrease morbidity and mortality.
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Affiliation(s)
- Daniel Hynes
- University of Massachusetts Medical School- Baystate Medical Center, Division of Interventional Radiology, Springfield, MA.
| | - Pouya Aghajafari
- University of Massachusetts Medical School- Baystate Medical Center, Division of Interventional Radiology, Springfield, MA
| | - Bertrand Janne d'Othée
- University of Massachusetts Medical School- Baystate Medical Center, Division of Interventional Radiology, Springfield, MA
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Percutaneous cholecystostomy in the management of acute cholecystitis - 10 years of experience. Wideochir Inne Tech Maloinwazyjne 2019; 14:516-525. [PMID: 31908697 PMCID: PMC6939213 DOI: 10.5114/wiitm.2019.84704] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/16/2019] [Indexed: 12/24/2022] Open
Abstract
Introduction The preferred treatment for acute cholecystitis is cholecystectomy, but for patients with precluded general anesthesia due to critical illness or multiple medical comorbidities it is not suitable. Cholecystostomy could be a minimally invasive therapeutic alternative. Aim To retrospectively evaluate the indications, technical features, efficacy, complications, patients’ development and relationships among monitored parameters of percutaneous computed tomography (CT)-guided cholecystostomies in cases of acute cholecystitis and find the role of this procedure in appropriate treatment selection. Material and methods Over the course of 10 years, 75 percutaneous cholecystostomy procedures in 69 patients were performed in cases with diagnosed acute cholecystitis, precluded general anesthesia and contraindicated cholecystectomy by an experienced surgeon and anesthesiologist. These interventions were done using only local anesthesia. The patients were men in 39 cases and women in 33 cases, aged 33 to 91 years. Results Technical success was achieved in all cases. The indications were sepsis in 34 (45.3%) cases, bridging acute gallbladder inflammatory status in 15 (20%) interventions, serious medical comorbidities in 8 (10.7%) cases, disseminated malignancy and cardiac failure in 6 cases each (both 8%) and neurological affections in 5 (6.5%) cases. Cholecystostomy was frequently the final solution in acalculous cholecystitis (79.3%). The 30-day mortality rate was determined at 10.7% and the overall complication rate was 21.3%, but all of these complications were managed conservatively or using minimally invasive treatment. Conclusions Percutaneous CT-guided cholecystostomy is reserved for patients with a serious medical status for various reasons that preclude surgical treatment and general anesthesia. Simultaneously, technical success and efficacy are high and the complication rate is acceptable.
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Image-Guided Cholecystostomy Tube Placement: Short- and Long-Term Outcomes of Transhepatic Versus Transperitoneal Placement. AJR Am J Roentgenol 2019; 212:201-204. [DOI: 10.2214/ajr.18.19669] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Percutaneous cholecystostomy as a nonsurgical option for treatment of acute cholecystitis in elderly patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Stanek A, Dohan A, Barkun J, Barkun A, Reinhold C, Valenti D, Cassinotto C, Gallix B. Percutaneous cholecystostomy: A simple bridge to surgery or an alternative option for the management of acute cholecystitis? Am J Surg 2018; 216:595-603. [DOI: 10.1016/j.amjsurg.2018.01.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 12/26/2017] [Accepted: 01/13/2018] [Indexed: 02/01/2023]
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Affiliation(s)
- Francesca M Dimou
- Department of Surgery, University of South Florida, 13220 USF Laurel Drive, 5th Floor, Tampa, FL 33612, USA
| | - Taylor S Riall
- Department of Surgery, University of Arizona, 1501 North Campbell Avenue, Room 4237, PO Box 245131, Tucson, AZ 85724-5131, USA.
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Park JM, Kang CD, Lee M, Park SC, Lee SJ, Jeon YH, Cho SW. Percutaneous cholecystostomy for biliary decompression in patients with cholangitis and pancreatitis. J Int Med Res 2018; 46:4120-4128. [PMID: 30027779 PMCID: PMC6166347 DOI: 10.1177/0300060518786632] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective This study was performed to assess the effectiveness and safety of
percutaneous cholecystostomy (PC) for biliary decompression. Methods We retrospectively analyzed our institution’s PC database from March 2015 to
August 2017 and selected patients with biliary obstruction. The primary
outcomes were the technical and clinical success rates. As secondary
outcomes, adverse events and pain after PC were compared with those of
patients who underwent PC for acute cholecystitis during the same
period. Results Twenty patients underwent PC for biliary obstruction (cholangitis, 19;
pancreatitis, 1). The technical and clinical success rates were 100%. The
median serum total bilirubin level decreased considerably from 4.5 to 1.4
mg/dL after PC. An adverse event (catheter migration) occurred in 1 patient,
and 17 patients developed pain after PC. During the same period, 104
patients underwent PC for cholecystitis. Adverse events occurred in 7
patients, and 62 developed pain. There was no significant difference in the
adverse event rate between the cholangitis/pancreatitis and cholecystitis
groups (5.0% vs. 6.7%, respectively), but pain occurred considerably more
frequently in the cholangitis/pancreatitis group (94.4% vs. 63.9%,
respectively). Conclusions PC is an effective and safe method for biliary decompression in selected
patients. However, attention should be paid to postoperative pain.
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Affiliation(s)
- Jin Myung Park
- Department of Internal Medicine, Kangwon National University
Hospital,
Kangwon
National University School of Medicine,
Chuncheon, Korea
| | - Chang Don Kang
- Department of Internal Medicine, Kangwon National University
Hospital,
Kangwon
National University School of Medicine,
Chuncheon, Korea
- Chang Don Kang, Department of Internal
Medicine, Kangwon National University Hospital, Kangwon National University
School of Medicine, 156 Baekryung-ro, Chuncheon, Kangwon-do 24289, Korea.
| | - Minjong Lee
- Department of Internal Medicine, Kangwon National University
Hospital,
Kangwon
National University School of Medicine,
Chuncheon, Korea
| | - Sung Chul Park
- Department of Internal Medicine, Kangwon National University
Hospital,
Kangwon
National University School of Medicine,
Chuncheon, Korea
| | - Sung Joon Lee
- Department of Internal Medicine, Kangwon National University
Hospital,
Kangwon
National University School of Medicine,
Chuncheon, Korea
| | - Yong Hwan Jeon
- Department of Radiology, Kangwon National University Hospital,
Kangwon
National University School of Medicine,
Chuncheon, Korea
| | - Seong Whi Cho
- Department of Radiology, Kangwon National University Hospital,
Kangwon
National University School of Medicine,
Chuncheon, Korea
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Pang KW, Tan CHN, Loh S, Chang KYS, Iyer SG, Madhavan K, Kow WCA. Outcomes of Percutaneous Cholecystostomy for Acute Cholecystitis. World J Surg 2016; 40:2735-2744. [DOI: 10.1007/s00268-016-3585-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Safety and effectiveness of percutaneous cholecystostomy in critically ill children who are immune compromised. Pediatr Radiol 2016; 46:1040-5. [PMID: 26886916 DOI: 10.1007/s00247-016-3562-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 01/04/2016] [Accepted: 01/24/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Acalculous cholecystitis is known to develop in critically ill patients without cystic duct obstruction. In the past, treatment for acalculous cholecystitis has been cholecystectomy; however, many children who are critically ill are Percutaneous cholecystostomy is likely the procedure of choice in this subgroup of patients. OBJECTIVE To assess the safety and effectiveness of percutaneous cholecystostomy in critically ill and immune-compromised children with acalculous cholecystitis. MATERIALS AND METHODS Retrospective review of immune-compromised and critically ill children who underwent percutaneous cholecystostomy between 2006 and 2013. Diagnostic imaging performed included ultrasound, CT and hepatobiliary scintigraphy. Every percutaneous cholecystostomy was performed using imaging guidance. RESULTS Ten critically ill and immune-compromised children with acalculous cholecystitis underwent percutaneous cholecystostomy. Seven boys and 3 girls, ranging in age from 10 months to 15 years 8 months, were treated. Six of the immune-compromised children had received a bone marrow transplant for leukemia (5 children) or severe combined immunodeficiency (SCID) (1 child), and ranged from 18 to 307 days post bone marrow transplant at the time of their percutaneous cholecystostomy. Of the remaining four immune-compromised children with acalculous cholecystitis who underwent percutaneous cholecystostomy, two had leukemia, one had SCID and lymphoma, and the fourth was undergoing treatment for undifferentiated germ cell tumor. The 10 percutaneous gallbladder drains were placed using a transhepatic approach, except one unintentional transperitoneal approach. There were no complications. Three gallbladder drains were removed in Interventional Radiology. Those three patients had a return to normal gallbladder function and didn't require cholecystectomy. Two drains were removed during cholecystectomy and another as an outpatient. Four patients died in the hospital due to multiorgan system failure, with indwelling gallbladder drains. CONCLUSION Percutaneous cholecystostomy is a safe procedure in immune-compromised and critically ill children with acalculous cholecystitis. Percutaneous cholecystostomy may obviate the need for future cholecystectomy.
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Anderloni A, Buda A, Vieceli F, Khashab MA, Hassan C, Repici A. Endoscopic ultrasound-guided transmural stenting for gallbladder drainage in high-risk patients with acute cholecystitis: a systematic review and pooled analysis. Surg Endosc 2016; 30:5200-5208. [PMID: 27059975 DOI: 10.1007/s00464-016-4894-x] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 03/07/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Endoscopic ultrasound-guided transmural stenting for gallbladder drainage is an emerging alternative for the treatment of acute cholecystitis in high-risk surgical patients. A variety of stents have been described, including plastic stents, self-expandable metal stents (SEMSs), and lumen-apposing metal stents (LAMSs). LAMSs represent the only specifically designed stent for transmural gallbladder drainage. A systematic review was performed to evaluate the feasibility and efficacy of EUS-guided drainage (EUS-GBD) in acute cholecystitis using different types of stents. METHODS A computer-assisted literature search up to September 2015 was performed using two electronic databases, MEDLINE and EMBASE. Search terms included MeSH and non-MeSH terms relating to acute cholecystitis, gallbladder drainage, endoscopic gallbladder drainage, endoscopic ultrasound gallbladder drainage, alone or in combination. Additional articles were retrieved by hand-searching from references of relevant studies. Pooled technical success, clinical success, and adverse event rates were calculated. RESULTS Twenty-one studies met the inclusion criteria, and the eligible cases were 166. The overall technical success rate, clinical success rate, and frequency of adverse events were 95.8, 93.4, and 12.0 %, respectively. The technical success rate was 100 % using plastic stents, 98.6 % using SEMSs, and 91.5 % using LAMSs. The clinical success rate was 100, 94.4, and 90.1 % after the deployment of plastic stents, SEMSs, and LAMSs, respectively. The frequency of adverse events was 18.2 % using plastic stents, 12.3 % using SEMSs, and 9.9 % using LAMSs. CONCLUSIONS Among the different drainage approaches in the non-surgical management of acute cholecystitis, EUS-guided transmural stenting for gallbladder drainage appears to be feasible, safe, and effective. LAMSs seem to have high potentials in terms of efficacy and safety, although further prospective studies are needed.
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Affiliation(s)
- Andrea Anderloni
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, 20089, Rozzano, Milan, Italy.
| | - Andrea Buda
- Gastroenterology Unit, Department of Gastrointestinal Oncological Surgery, 'S. Maria del Prato' Hospital, Feltre, Italy
| | - Filippo Vieceli
- Gastroenterology Unit, Department of Gastrointestinal Oncological Surgery, 'S. Maria del Prato' Hospital, Feltre, Italy
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Cesare Hassan
- Gastroenterology and Digestive Endoscopy, 'Nuovo Regina Margherita' Hospital, Rome, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, 20089, Rozzano, Milan, Italy.,Humanitas University, Rozzano, Milan, Italy
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Cortázar García R, Sánchez Rodríguez P, Ramos García M. Colecistostomía percutánea como tratamiento de la colecistitis aguda en pacientes con alto riesgo quirúrgico. RADIOLOGIA 2016; 58:136-44. [DOI: 10.1016/j.rx.2015.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 09/19/2015] [Accepted: 09/27/2015] [Indexed: 11/26/2022]
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Percutaneous cholecystostomy to treat acute cholecystitis in patients with high risk for surgery. RADIOLOGIA 2016. [DOI: 10.1016/j.rxeng.2016.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Duncan C, Hunt SJ, Gade T, Shlansky-Goldberg RD, Nadolski GJ. Outcomes of Percutaneous Cholecystostomy in the Presence of Ascites. J Vasc Interv Radiol 2016; 27:562-6.e1. [PMID: 26898624 DOI: 10.1016/j.jvir.2015.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 12/03/2015] [Accepted: 12/03/2015] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To evaluate whether the presence of ascites increases complications following placement of percutaneous cholecystostomy tubes (PCTs). MATERIALS AND METHODS Retrospective review of all transhepatic PCTs placed between January 2005 and June 2014 was performed: 255 patients were included (median age of 65 y; range, 20-95 y). Of these patients, 97 had ascites and 158 had no ascites or only pelvic fluid. In all, 115 patients had calculous cholecystitis (45%), 127 had acalculous cholecystitis (50%), and 13 had common bile duct obstruction (5%). The primary outcome of interest was all complications, including bile peritonitis, pericatheter leakage requiring PCT change, pericholecystic abscess formation, drain dislodgment, or death from biliary sepsis within 14 days of initial PCT insertion. RESULTS The overall complication rate was 11% among patients with ascites (n = 11), compared with 10% in those without (n = 16; P = .834). No difference was found between the two groups in any one complication. The overall outcome of PCT drainage differed between groups, with significantly shorter survival times in patients with ascites. Patients with ascites underwent cholecystectomy less often than patients without ascites (21% vs 39%; P = .002). Likewise, patients with ascites were more likely than those without ascites to die with the PCT in place (49% vs 25%; P = .001). CONCLUSIONS Frequencies of complications following PCT insertion were similar in patients with and without ascites. Additionally, the overall complication rate was low and not significantly different between the two groups. These observations support the use of PCT placement in patients with ascites.
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Affiliation(s)
- Christopher Duncan
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104
| | - Stephen J Hunt
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104
| | - Terence Gade
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104
| | - Richard D Shlansky-Goldberg
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104
| | - Gregory J Nadolski
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104.
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Chou CK, Lee KC, Chan CC, Perng CL, Chen CK, Fang WL, Lin HC. Early Percutaneous Cholecystostomy in Severe Acute Cholecystitis Reduces the Complication Rate and Duration of Hospital Stay. Medicine (Baltimore) 2015; 94:e1096. [PMID: 26166097 PMCID: PMC4504525 DOI: 10.1097/md.0000000000001096] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The optimal timing of percutaneous cholecystostomy for severe acute cholecystitis is unclear. The aim of this study was to investigate the timing of percutaneous cholecystostomy and its relationship to clinical outcomes in patients with inoperable acute severe cholecystitis.From 2008 to 2010, 209 consecutive patients who were admitted to our hospital due to acute cholecystitis and were treated by percutaneous cholecystostomy were retrospectively reviewed. The time periods from symptom onset to when percutaneous cholecystostomy was performed and when patients were discharged were recorded.In the 209 patients, the median time period between symptom onset and percutaneous cholecystostomy was 23 hours (range, 3-95 hours). The early intervention group (≤24 hours, n = 109) had a significantly lower procedure-related bleeding rate (0.0% vs 5.0%, P = 0.018) and shorter hospital stay (15.8 ± 12.9 vs 21.0 ± 17.5 days) as compared with the late intervention group (>24 hours, n = 100). Delayed percutaneous cholecystostomy was a significant independent factor for a longer hospital stay (odds ratio 3.03, P = 0.001).In inoperable patients with acute severe cholecystitis, early percutaneous cholecystostomy reduced hospital stay and procedure-related bleeding without increasing the mortality rate.
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Affiliation(s)
- Chung-Kai Chou
- From the Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei (CK Chou, KCL, CCC, CLP, HCL); Department of Medicine, National Yang-Ming University School of Medicine (CK Chou, KCL, CCC, CLP, HCL); Division of Gastroenterol- ogy, Department of Medicine, National Yang-Ming University Hospital, Ilan (CK Chou); Department of Radiology, Taipei Veterans General Hospital (CK Chen); and Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan (WLF)
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Blanco PA, Do Pico JJ. Ultrasound-guided percutaneous cholecystostomy in acute cholecystitis: case vignette and review of the technique. J Ultrasound 2015; 18:311-5. [PMID: 26550068 DOI: 10.1007/s40477-015-0173-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 06/06/2015] [Indexed: 10/23/2022] Open
Abstract
Acute cholecystitis is a frequent condition. Although cholecystectomy is the indicated treatment of this entity, it cannot be performed in some high-risk surgery patients, such as critically ill or those with multiple comorbidities. In these non-uncommon scenarios, percutaneous cholecystostomy is the recommended alternative treatment, which allows immediate decompression and drainage of the acutely inflamed gallbladder and thus reducing the patient's symptoms and the systemic inflammatory response. Ultrasound is the imaging method of choice to guide the percutaneous cholecystostomy procedure due to its real-time guidance, lack of ionizing radiation and portability, avoiding the need to transfer unhealthy patients to the radiology department. We will review the ultrasound-guided percutaneous cholecystostomy procedure, of special interest for radiologists, surgeons, and also intensive care and emergency physicians.
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Affiliation(s)
- Pablo A Blanco
- Intensive Care Unit, Hospital Dr. Emilio Ferreyra, 4801, 59 St., 7630 Necochea, Argentina
| | - Juan J Do Pico
- Department of Surgery, Hospital Dr. Emilio Ferreyra, Necochea, Argentina
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Acute acalculous cholecystitis in the critically ill: risk factors and surgical strategies. Langenbecks Arch Surg 2014; 400:421-7. [PMID: 25539703 DOI: 10.1007/s00423-014-1267-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 12/15/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE Acute acalculous cholecystitis (AAC) is characterized by severe gallbladder inflammation without cystic duct obstruction. Critical illness and neurological deficits are often associated with AAC, and early radiologic imaging is necessary for the detection and timely treatment of AAC. In critically ill patients, effective surgical management is difficult. This review examines the three common surgical treatments for AAC (open cholecystectomy (OC), laparoscopic cholecystectomy (LC), or percutaneous cholecystostomy (PC)), their prevalence in current literature, and the perioperative outcomes of these different approaches using a large retrospective database. MATERIALS AND METHODS This review examined literature gathered from PubMed and Google Scholar to select more than 50 sources with data pertinent to AAC; of which 20 are described in a summary table. Outcomes from our previous research and several updated results were obtained from the University HealthSystem Consortium (UHC) database. RESULTS LC has proven effective in treating AAC when the risks of general anesthesia and the chance for conversion to OC are low. In critically ill patients with multiple comorbidities, PC or OC may be the only available options. Data in the literature and an examination of outcomes within a national database indicate that for severely ill patients, PC may be safer and met with better outcomes than OC for the healthier set of AAC patients. CONCLUSIONS We suggest a three-pronged approach to surgical resolution of AAC. Patients that are healthy enough to tolerate LC should undergo LC early in the course of the disease. In critically ill patients, patients with multiple comorbidities, a high conversion risk, or who are poor surgical candidates, PC may be the safest and most successful intervention.
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Abdulaal AF, Sharouda SK, Mahdy HA. Percutaneous cholecystostomy treatment for acute cholecystitis in high risk patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Stenting of the Cystic Duct in Benign Disease: A Definitive Treatment for the Elderly and Unwell. Cardiovasc Intervent Radiol 2014; 38:964-70. [PMID: 25385254 DOI: 10.1007/s00270-014-1014-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE There have been few case reports describing cystic duct stent insertion in the management of acute cholecystitis secondary to benign disease with no case series published to date. We present our series demonstrating the role of cystic duct stents in managing benign gallbladder disease in those patients unfit for surgery. MATERIALS AND METHODS Thirty three patients unfit for surgery in our institution underwent cystic duct stent insertion for the management of acute cholecystitis in the period June 2008 to June 2013. Patients underwent a mixture of transperitoneal and transhepatic gallbladder puncture. The cystic duct was cannulated with a hydrophilic guidewire which was subsequently passed through the common bile duct and into the duodenum. An 8Fr 12-cm double-pigtail stent was placed with the distal end lying within the duodenum and the proximal end within the gallbladder. RESULTS Ten patients presented with gallbladder perforation, 21 patients with acute cholecystitis, 1 with acute cholangitis and 1 with necrotising pancreatitis. The technical success rate was 91%. We experienced a 13% complication rate with 3% mortality rate at 30 days. CONCLUSION Cystic duct stent insertion can be successfully used to manage acute cholecystitis, gallbladder empyema or gallbladder perforations in those unfit for surgery and should be considered alongside external gallbladder drainage as a definitive mid-term treatment option.
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Timing and Choice of Intervention Influences Outcome in Acute Cholecystitis. Surg Laparosc Endosc Percutan Tech 2014; 24:414-9. [DOI: 10.1097/sle.0000000000000075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Venara A, Carretier V, Lebigot J, Lermite E. Technique and indications of percutaneous cholecystostomy in the management of cholecystitis in 2014. J Visc Surg 2014; 151:435-9. [PMID: 25168577 DOI: 10.1016/j.jviscsurg.2014.06.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The gold standard in treatment of acute cholecystitis is cholecystectomy associated with antibiotics. In certain circumstances, percutaneous cholecystostomy is an interventional alternative. Percutaneous cholecystostomy is usually performed under local anesthesia by the radiologist using ultrasonographic or CT guidance. A drain can be inserted either through a trans-hepatic or a trans-peritoneal approach. Complications occur in nearly 10% of cases including hemorrhage, hemobilia, pneumothorax or bile leaks, depending on whether the approach was trans-hepatic or trans-peritoneal. The main indications for percutaneous cholecystostomy are resistance to medical treatment or severely-ill patients in intensive care. Drains should be maintained 3 to 6 weeks before removal. In patients with good general condition (ASA score I-II), secondary cholecystectomy can be recommended to avoid recurrence.
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Affiliation(s)
- A Venara
- Service de chirurgie digestive et endocrinienne, CHU, 4, rue Larrey, 49933 Angers cedex, France
| | - V Carretier
- Service de radiologie, CHU, 4, rue Larrey, 49933 Angers cedex, France
| | - J Lebigot
- Service de radiologie, CHU, 4, rue Larrey, 49933 Angers cedex, France
| | - E Lermite
- Service de chirurgie digestive et endocrinienne, CHU, 4, rue Larrey, 49933 Angers cedex, France.
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Moon EK, Wang W, Newman JS, Bayona-Molano MDP. Challenges in interventional radiology: the pregnant patient. Semin Intervent Radiol 2013; 30:394-402. [PMID: 24436567 PMCID: PMC3835597 DOI: 10.1055/s-0033-1359734] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A pregnant patient presenting to interventional radiology (IR) has a different set of needs from any other patient requiring a procedure. Often, the patient's care can be in direct conflict with the growth and development of the fetus, whether it be optimal fluoroscopic imaging, adequate sedation of the mother, or the timing of the needed procedure. Despite the additional risks and complexities associated with pregnancy, IR procedures can be performed safely for the pregnant patient with knowledge of the special and general needs of the pregnant patient, use of acceptable medications and procedures likely to be encountered during pregnancy, in addition to strategies to protect the patient and her fetus from the hazards of radiation.
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Affiliation(s)
- Eunice K. Moon
- Department of Vascular and Interventional Radiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Weiping Wang
- Department of Vascular and Interventional Radiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - James S. Newman
- Department of Vascular and Interventional Radiology, Cleveland Clinic Foundation, Cleveland, Ohio
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Weber DG, Bendinelli C, Balogh ZJ. Damage control surgery for abdominal emergencies. Br J Surg 2013; 101:e109-18. [PMID: 24273018 DOI: 10.1002/bjs.9360] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2013] [Indexed: 01/05/2023]
Abstract
BACKGROUND Damage control surgery is a management sequence initiated to reduce the risk of death in severely injured patients presenting with physiological derangement. Damage control principles have emerged as an approach in non-trauma abdominal emergencies in order to reduce mortality compared with primary definitive surgery. METHODS A PubMed/MEDLINE literature review was conducted of data available over the past decade (up to August 2013) to gain information on current understanding of damage control surgery for abdominal surgical emergencies. Future directions for research are discussed. RESULTS Damage control surgery facilitates a strategy for life-saving intervention for critically ill patients by abbreviated laparotomy with subsequent reoperation for delayed definitive repair after physiological resuscitation. The six-phase strategy (including damage control resuscitation in phase 0) is similar to that for severely injured patients, although non-trauma indications include shock from uncontrolled haemorrhage or sepsis. Minimal evidence exists to validate the benefit of damage control surgery in general surgical abdominal emergencies. The collective published experience over the past decade is limited to 16 studies including a total of 455 (range 3-99) patients, of which the majority are retrospective case series. However, the concept has widespread acceptance by emergency surgeons, and appears a logical extension from pathophysiological principles in trauma to haemorrhage and sepsis. The benefits of this strategy depend on careful patient selection. Damage control surgery has been performed for a wide range of indications, but most frequently for uncontrolled bleeding during elective surgery, haemorrhage from complicated gastroduodenal ulcer disease, generalized peritonitis, acute mesenteric ischaemia and other sources of intra-abdominal sepsis. CONCLUSION Damage control surgery is employed in a wide range of abdominal emergencies and is an increasingly recognized life-saving tactic in emergency surgery performed on physiologically deranged patients.
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Affiliation(s)
- D G Weber
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, New South Wales, Australia
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Acute cholecystitis: We can drain it! GASTROINTESTINAL INTERVENTION 2013. [DOI: 10.1016/j.gii.2013.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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